How should I manage a patient with oral ulcers and suspected Behçet's disease?

Management of a patient presenting with oral ulcers and suspected Behçet's disease requires a comprehensive approach combining symptomatic treatment of ulcers, assessment for systemic involvement, and specialist referral for confirmation and further management. Initially, advise the patient to avoid known ulcer triggers such as oral trauma and certain foods (e.g., coffee, chocolate, peanuts, gluten-containing products), and recommend avoiding toothpaste containing sodium lauryl sulfate to reduce irritation ¹. Provide symptomatic relief using topical therapies such as lidocaine for anaesthesia, benzydamine for analgesic and anti-inflammatory effects, and chlorhexidine gluconate mouthwash to prevent secondary infection ¹. If ulcers are severe or recurrent, topical corticosteroids like hydrocortisone or beclomethasone spray can be used, with systemic corticosteroids (e.g., prednisolone) reserved for severe cases ¹. Consider correcting any nutritional deficiencies, particularly vitamin B12, irrespective of serum levels, as this may aid healing ¹.

Given the suspicion of Behçet's disease, which is a multisystem inflammatory disorder characterized by recurrent oral and genital ulcers, ocular inflammation, and other systemic manifestations, urgent referral to a specialist (rheumatologist or oral medicine specialist) is essential for diagnosis confirmation and systemic evaluation ¹; (Dalvi et al., 2012). Diagnosis is clinical, supported by criteria including recurrent oral ulcers plus two of genital ulcers, eye lesions, skin lesions, or a positive pathergy test (Dalvi et al., 2012). Early specialist involvement is critical to assess for systemic involvement such as ocular, neurological, or vascular disease, which may require immunosuppressive therapy (Yazici, 2020).

Systemic treatment options for Behçet's disease include corticosteroids and immunosuppressants such as azathioprine, colchicine, or biologics in refractory cases, tailored according to organ involvement and severity (Yazici, 2020). Pain management and oral care remain important supportive measures. Monitor for complications and provide patient education about the chronic relapsing nature of the disease (Dalvi et al., 2012). If oral ulcers persist beyond three weeks without clear diagnosis or respond poorly to initial treatment, consider urgent referral to exclude malignancy or other serious pathology ⁴.